Provider Demographics
NPI:1407319486
Name:PARR, JOAN LEDVINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:LEDVINA
Last Name:PARR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-2007
Mailing Address - Country:US
Mailing Address - Phone:410-666-0480
Mailing Address - Fax:
Practice Address - Street 1:13 GLENBROOK DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-2007
Practice Address - Country:US
Practice Address - Phone:410-666-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01523103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist